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Rogero RG, Swamy S, Bettin CC. The Differentiation Between Infection and Acute Charcot. Orthop Clin North Am 2024; 55:299-309. [PMID: 38403375 DOI: 10.1016/j.ocl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The differentiation between acute Charcot neuroarthropathy and infection in the foot and ankle should be supported by multiple criteria. A detailed history and physical examination should always be completed. Plain radiographs should be performed, though advanced imaging, currently MRI, is more helpful in diagnosis. Scintigraphy and PET may become the standard imaging modalities once they are more clinically available due to their reported increased accuracy. Laboratory analysis can also act as a helpful diagnostic tool. Histopathology with culturing should be performed if osteomyelitis is suspected. The prompt diagnosis and initiation of treatment is vital to reducing patient morbidity and mortality.
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Affiliation(s)
- Ryan G Rogero
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite #510, Memphis, TN 38104, USA
| | - Samhita Swamy
- University of Tennessee Health Science Center College of Medicine, 847 E Parkway S, Memphis, TN 38104, USA
| | - Clayton C Bettin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite #510, Memphis, TN 38104, USA.
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2
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Kim NE, Lee WJ, Jung JK, Song JH, Joa KL, Yang CW, Jung EC, Jo SM, Ko YS. Diabetic Neuropathy and Minimum Effective Anesthetic Concentration of Mepivacaine for Axillary Brachial Plexus Block: A Prospective Observational Study. J Pers Med 2024; 14:353. [PMID: 38672980 PMCID: PMC11051194 DOI: 10.3390/jpm14040353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Nerves in patients with diabetic neuropathy (DN) show increased susceptibility to local anesthetics, potentially requiring a decreased dose. We investigated whether the minimum effective anesthetic concentration (MEAC) of mepivacaine for successful axillary block is lower in patients with DN than in those without. This prospective observational study included patients with DN (n = 22) and without diabetes (n = 22) at a tertiary care center. Patients received an ultrasound-guided axillary block with 30 mL of mepivacaine for anesthesia. The mepivacaine concentration used in each patient was calculated using Dixon's up-and-down method. A block was considered successful if all four sensory nerves had a score of 1 or 2 within 30 min with no pain during surgery. The primary outcome was the MEAC of mepivacaine, and the secondary outcomes included the minimal nerve stimulation intensity for the musculocutaneous nerve and the occurrence of adverse events. The MEAC50 was 0.55% (95% CI 0.33-0.77%) in patients without diabetes and 0.58% (95% CI 0.39-0.77%) in patients with DN (p = 0.837). The MEAC90 was 0.98% (95% CI 0.54-1.42%) in patients without diabetes and 0.96% (95% CI 0.57-1.35%) in patients with DN (p = 0.949). The stimulation threshold for the musculocutaneous nerve was significantly different between groups (0.49 mA vs. 0.19 mA for patients with vs. without diabetes; p = 0.002). In conclusion, the MEAC of mepivacaine for a successful axillary block is not lower in patients with DN.
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Affiliation(s)
- Na-Eun Kim
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
| | - Woo-Joo Lee
- The Department of Public Health Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea;
| | - Jong-Kwon Jung
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
| | - Jang-Ho Song
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
| | - Kyung-Lim Joa
- The Department of Physical and Rehabilitation Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea;
| | - Chun-Woo Yang
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
| | - Eui-Chan Jung
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
| | - Soo-Man Jo
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
| | - Yeong-Seung Ko
- The Department of Anesthesiology and Pain Medicine, School of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea; (N.-E.K.); (J.-K.J.); (J.-H.S.); (E.-C.J.); (S.-M.J.); (Y.-S.K.)
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Gonzalez Bravo C, Sabree SA, Dukes K, Adeagbo MJ, Edwards S, Wainwright K, Schaeffer SE, Villa A, Wilks AD, Carvour ML. Diabetes care in the pandemic era in the Midwestern USA: a semi-structured interview study of the patient perspective. BMJ Open 2024; 14:e081417. [PMID: 38458805 DOI: 10.1136/bmjopen-2023-081417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES To understand patients' experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA. DESIGN Community-engaged, semi-structured interviews were conducted by medical student researchers trained in qualitative interviewing. Transcripts were prepared and coded in the language in which the interview was conducted (English or Spanish). Thematic analysis was conducted, and data saturation was achieved. SETTING The study was conducted in communities in Eastern and Western Iowa. PARTICIPANTS Adults with diabetes (n=20) who were fluent in conversational English or Spanish were interviewed. One-third of participants were residents of areas designated as federal primary healthcare professional shortage areas and/or medically underserved areas, and more than half were recruited from medical clinics that offer care at no cost. RESULTS Themes across both English and Spanish transcripts included: (1) perspectives of diabetes, care providers and care management; (2) challenges and barriers affecting diabetes care; and (3) participant feedback and recommendations. Participants reported major constraints related to provider availability, costs of care, access to nutrition counselling and mental health concerns associated with diabetes care during the pandemic. Participants also reported a lack of shared decision-making regarding some aspects of care, including amputation. Finally, participants recognised systems-level challenges that affected both patients and providers and expressed a preference for proactive collaboration with healthcare teams. CONCLUSIONS These findings support enhanced engagement of rural, medically underserved and minoritised groups as stakeholders in diabetes care, diabetes research and diabetes provider education.
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Affiliation(s)
- Carolina Gonzalez Bravo
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Shakoora A Sabree
- Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kimberly Dukes
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Morolake J Adeagbo
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Sarai Edwards
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Kasey Wainwright
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sienna E Schaeffer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Aneli Villa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Aloha D Wilks
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Martha L Carvour
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa College of Public Health, Iowa City, Iowa, USA
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Zhu G, Xu J, Dai H, Min D, Guo G. Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery. Diabetol Metab Syndr 2023; 15:213. [PMID: 37880794 PMCID: PMC10601239 DOI: 10.1186/s13098-023-01185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) represent a significant foot-related concern for patients with multiple co-morbidities, and surgical intervention is often employed. Notably, peripheral nerve block anesthesia (PNB) has emerged as a new approach for the surgical management of DFUs, providing sustained hemodynamic stability and superior postoperative pain control compared to general anesthesia (GEA). METHODS The present study utilized a retrospective analysis of hospitalized patients who met the inclusion criteria for DFUs over a period of 7 years. Patients were categorized into two groups based on the type of anesthesia employed during the procedure: GEA or PNB. Extensive patient information was gathered and analyzed, such as demographics, intraoperative hemodynamic parameters, numeric rating scale (NRS) scores, and healing outcomes. The preliminary results assessed in this study were intraoperative hemodynamic stability and postoperative analgesic efficacy. RESULTS During the study period, 117 patients received surgical therapy based on GEA, while 145 patients received PNB. Notably, the mean intraoperative blood pressure was significantly lower in the GEA group, and this difference remained statistically significant even after Bonferroni adjustment using linear mixed models. Additionally, the frequency of hypotensive episodes was higher in the GEA group (P < 0.05). Furthermore, the perioperative transfusion volume, overall intraoperative fluid input, and intraoperative bleeding volume were significantly more significant in the GEA group than in the PNB group. The postoperative pain NRS scores differed considerably between the two groups (Bonferroni corrected P < 0.01), with the GEA group exhibiting higher opioid consumption on the day of surgery and the first postoperative day when using patient-controlled intravenous analgesia (PCIA). Supplemental analgesic medication was more significant in the GEA group 24 h postoperatively. However, the two groups had no difference in hospital stay or treatment outcomes. There was no difference between the two groups regarding secondary surgery and amputation procedures. Although the 5-year mortality rate is 30.5%, no significant difference in mortality rates between the two groups was observed. CONCLUSIONS Compared to GEA, PNB is a safe and effective alternative therapy for managing DFUs. Our findings suggest that PNB administration during surgical intervention for this condition results in more stable intraoperative hemodynamics and superior postoperative analgesic effects, despite no significant difference in overall treatment outcomes between the two groups. The two groups did not differ in re-surgery, amputation, or 5-year mortality.
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Affiliation(s)
- Gehua Zhu
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiamin Xu
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hanying Dai
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dinghong Min
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guanghua Guo
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, China.
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Kohlman-Trigoboff D. Footcare and peripheral arterial disease. JOURNAL OF VASCULAR NURSING 2023; 41:144-146. [PMID: 37684092 DOI: 10.1016/j.jvn.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Changes in the feet occur with age which can cause pain and other foot pathologies that can lead to falls, foot ulcers and amputation. Some older adults may have difficulty doing foot hygiene due to physical or mental decline such as body habitus, poor vision, arthritic problems to mention a few.1 The presence of PAD creates an increased risk of foot ulcers, leg/foot infection and lower extremity amputation, especially in diabetic patients. PAD is often asymptomatic;2 however PAD prevalence increases with age, the majority of which occurs over age 65.3 African-American and Native Americans have approximately twice the prevalence of PAD than that of non-Hispanic Whites.4 There is a 40% rate of death at 5 years following the development of a foot ulcer in PAD patients.5 Foot ulcers require increased medical office visits, increased resource utilization, increased patient anxiety/depression and reduced quality of life (QOL).6 However, routine foot examinations and educating patients and their families in proper footcare can detect common foot problems, uncover functional decline and PAD, and prevent falls. In patients at-risk for foot ulcers, a yearly comprehensive foot evaluation can prevent foot ulcers, foot pain, and lower extremity amputation. Evaluation and early recognition of PAD can reduce morbidity and mortality.6,8,13.
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6
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Mirghani HO. Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers: A systematic review and meta-analysis. World J Meta-Anal 2023; 11:218-227. [DOI: 10.13105/wjma.v11.i5.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/06/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The definition of diabetic foot syndrome (DFS) varies depending on the location and resources. Few classifications are available according to the indication. DF ulcers and vitamin D deficiency are common diseases among patients with diabetes. Previous literature has shown an association between DF ulcer (DFU) and vitamin D deficiency. However, the available meta-0analysis was limited by substantial bias.
AIM To investigate the association between DFUs and vitamin D levels.
METHODS We searched PubMed, MEDLINE, and Cochrane Library, EBSCO, and Google Scholar for studies comparing vitamin D levels and DF. The keywords DFU, DFS, diabetic septic foot, vitamin D level, 25-hydroxy vitamin D, vitamin D status, and vitamin D deficiency were used. The search engine was set for articles published during the period from inception to October 2022. A predetermined table was used to collect the study information.
RESULTS Vitamin D level was lower among patients with DFU compared to their counterparts [odds ratio (OR): -5.77; 95% confidence interval (CI): -7.87 to -3.66; χ2 was 84.62, mean difference, 9; I2 for heterogeneity, 89%; P < 0.001 and P for overall effect < 0.001]. The results remained robust for hospitalized patients (OR: -6.32 95%CI: -11.66 to -0.97; χ2 was 19.39; mean difference, 2; I2 for heterogeneity, 90%; P = 0.02).
CONCLUSION Vitamin D was lower among outpatients and hospitalized patients with DFUs. Further larger randomized controlled trials are needed.
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Affiliation(s)
- Hyder Osman Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Saudi Arabia, Tabuk 3378, Saudi Arabia
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7
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Peng B, Min R. Development of predictive nomograms clinical use to quantify the risk of diabetic foot in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1186992. [PMID: 37388212 PMCID: PMC10304289 DOI: 10.3389/fendo.2023.1186992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The aim of the study was to explore the risk factors for diabetic foot disease in patients with type 2 diabetes mellitus and to establish and verify the nomogram model of DF risk in patients with T2DM. Methods The clinical data of 705 patients with type 2 diabetes who were hospitalized in our hospital from January 2015 to December 2022 were analyzed retrospectively. According to random sampling, the patients were divided into two groups: the training set (DF = 84; simple T2DM = 410) and the verification set (DF = 41; simple T2DM = 170). Univariate and multivariate logistic regression analysis was used to screen the independent risk factors for DF in patients with T2DM in the training set. According to the independent risk factors, the nomogram risk prediction model is established and verified. Results Logistic regression analysis showed age (OR = 1.093, 95% CI 1.062-1.124, P <0.001), smoking history (OR = 3.309, 95% CI 1.849-5.924, P <0.001), glycosylated hemoglobin (OR = 1.328, 95% CI 1.173-1.502, P <0.001), leukocyte (OR = 1.203, 95% CI 1.076-1.345, and LDL-C (OR = 2.002, 95% CI 1.463-2.740), P <0.001) was independent risk factors for T2DM complicated with DF. The area of the nomogram model based on the above indexes under the ROC curve of the training set and the verification set is 0.827 and 0.808, respectively; the correction curve shows that the model has good accuracy; and the DCA results show that when the risk threshold is between 0.10-0.85 (training set) and 0.10-0.75 (verification set), the clinical practical value of the model is higher. Conclusion The nomogram model constructed in this study is of high value in predicting the risk of DF in patients with T2DM and is of reference value for clinicians to identify people at high risk of DF and provide them with early diagnosis and individual prevention.
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Affiliation(s)
- Bocheng Peng
- Department of Pain, Wuhan Fourth Hospital, Wuhan, China
| | - Rui Min
- Department of Geriatrics, Wuhan Fourth Hospital, Wuhan, China
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Feron F, Amouyal C, Hartemann A, Van GH, Bourron O, Dierick-Gallet A, Michaux C, Santos MD, Baudot M, Devaux G, Taboureau O, Andreelli F. The short-term prognosis of diabetic foot ulceration is independent of nutritional status at admission. J Wound Care 2023; 32:312-317. [PMID: 37094929 DOI: 10.12968/jowc.2023.32.5.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Diabetic foot ulcers are one of the complications of diabetes. Malnutrition is one of the risk factors for wounds but, on the other hand, diabetic foot ulceration may promote malnutrition. In this single-centre retrospective study we evaluated the frequency of malnutrition at first admission and the severity of foot ulceration. We demonstrated that malnutrition at admission correlated with duration of hospitalisation and with death rate rather than with the risk of amputation. Our data challenged the concept that protein-energy deficiency may worsen the prognosis of diabetic foot ulcers. Nevertheless, it is still important to screen nutritional status at baseline and during the follow-up in order to start specific nutritional support therapy as soon as possible in order to reduce morbidity/mortality related to malnutrition.
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Affiliation(s)
- Florine Feron
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Chloé Amouyal
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Agnès Hartemann
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Georges Ha Van
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Olivier Bourron
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Anne Dierick-Gallet
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Caroline Michaux
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Maude Dos Santos
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Magali Baudot
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Gaelle Devaux
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Olivier Taboureau
- Université de Paris, BFA, Team CMPLI, Inserm U1133, CNRS UMR 8251, Paris, France
| | - Fabrizio Andreelli
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
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Berchiolli R, Bertagna G, Adami D, Canovaro F, Torri L, Troisi N. Chronic Limb-Threatening Ischemia and the Need for Revascularization. J Clin Med 2023; 12:jcm12072682. [PMID: 37048765 PMCID: PMC10095037 DOI: 10.3390/jcm12072682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical and endovascular procedures should be well established, but there is still a lack of consensus concerning the best treatment strategy. The aim of this manuscript is to offer an overview of the contemporary management of CLTI patients, with a focus on the concept that evidence-based revascularization (EBR) could help surgeons to provide more appropriate treatment, avoiding improper procedures, as well as too-high-risk ones. METHODS We performed a search on MEDLINE, Embase, and Scopus from 1 January 1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150 articles were screened, but only those of high quality were considered and included in a narrative synthesis. RESULTS Global Vascular Guidelines have improved and standardized the way to classify and manage CLTI patients with evidence-based revascularization (EBR). Nevertheless, considering that not all patients are suitable for revascularization, a key strategy could be to stratify unfit patients by considering both clinical and non-clinical risk factors, in accordance with the concept of individual residual risk for every patient. The recent BEST-CLI trial established the superiority of autologous vein bypass graft over endovascular therapy for the revascularization of CLTI patients. However, no-option CLTI patients still represent a critical issue. CONCLUSIONS The surgeon's experience and skillfulness are the cornerstones of treatment and of a multidisciplinary approach. The recent BEST-CLI trial established that open surgical peripheral vascular surgery could guarantee better outcomes than the less invasive endovascular approach.
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Affiliation(s)
- Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Francesco Canovaro
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Torri
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
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Al-Nimer M, Ratha R. Cardiometabolic risk factors and electrocardiogram results in type 2 diabetes patients with or without non-infected foot ulcers: A comparative study. DIABETES MELLITUS 2023. [DOI: 10.14341/dm12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND: Numerous investigations have demonstrated that type-2 diabetes (T2D) causes electrocardiographic alterations, whether or not there are microvascular or macrovascular problems.AIM: With respect to glycemic control and the accompanying cardio-metabolic risk factors, the goal of this study was to demonstrate the variations in electrocardiogram records between T2D patients with non-infected diabetic foot ulcers (DFUs) and those without ulcers.METHODS: This study was performed in the Shar Teaching Hospital in the Sulaimani Governorate-Iraq from July 2018 to June 2019. 167 participants were grouped into Group I (T2D, n=72); Group II (T2D with non-infected diabetic foot ulcers, n=65) and Group III (healthy subjects, n= 30). Blood pressure, electrocardiography, and anthropometric measurements were taken. Fasting serum glucose and lipid profiles were assessed as part of laboratory tests.RESULTS: Group II patients significantly differed from Group I by having lower diastolic blood pressure, a higher pulse pressure index, and a higher fasting serum glucose. The Group I patients had a significantly higher heart rate, a shortening of TQ-interval and widening of QRS dispersion. Group II patients had a significantly shorter TQ-interval compared with the corresponding value of Group I patients (523.6±136.4ms versus 579.2±110.0ms, respectively). These changes in the electrocardiograms are not related to the cardiometabolic risk factors.CONCLUSION: In the non-infected diabetic foot, the TQ-interval, a measure of ventricular repolarization impairment, is much shorter and is linked to a broad pulse pressure. According to this finding, the electrocardiographic abnormalities are a result of cardiovascular autonomic dysfunction.
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Affiliation(s)
| | - R. Ratha
- College of Pharmacy, University of Sulaimani; Qaiwan International University
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Rai V, Moellmer R, Agrawal DK. Role of fibroblast plasticity and heterogeneity in modulating angiogenesis and healing in the diabetic foot ulcer. Mol Biol Rep 2023; 50:1913-1929. [PMID: 36528662 DOI: 10.1007/s11033-022-08107-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
Chronic diabetic foot ulcers (DFUs) are an important clinical issue faced by clinicians despite the advanced treatment strategies consisting of wound debridement, off-loading, medication, wound dressings, and keeping the ulcer clean. Non-healing DFUs are associated with the risk of amputation, increased morbidity and mortality, and economic stress. Neo-angiogenesis and granulation tissue formation are necessary for physiological DFU healing and acute inflammation play a key role in healing. However, chronic inflammation in association with diabetic complications holds the ulcer in the inflammatory phase without progressing to the resolution phase contributing to non-healing. Fibroblasts acquiring myofibroblasts phenotype contribute to granulation tissue formation and angiogenesis. However, recent studies suggest the presence of five subtypes of fibroblast population and of changing density in non-healing DFUs. Further, the association of fibroblast plasticity and heterogeneity with wound healing suggests that the switch in fibroblast phenotype may affect wound healing. The fibroblast phenotype shift and altered function may be due to the presence of chronic inflammation or a diabetic wound microenvironment. This review focuses on the role of fibroblast plasticity and heterogeneity, the effect of hyperglycemia and inflammatory cytokines on fibroblasts, and the interaction of fibroblasts with other cells in diabetic wound microenvironment in the perspective of DFU healing. Next, we summarize secretory, angiogenic, and angiostatic phenotypes of fibroblast which have been discussed in other organ systems but not in relation to DFUs followed by the perspective on the role of their phenotypes in promoting angiogenesis in DFUs.
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Affiliation(s)
- Vikrant Rai
- Department of Translational Research, Western University of Health Sciences, 91766, Pomona, CA, USA.
| | - Rebecca Moellmer
- College of Podiatric Medicine, Western University of Health Sciences, 91766, Pomona, CA, USA
| | - Devendra K Agrawal
- Department of Translational Research, Western University of Health Sciences, 91766, Pomona, CA, USA
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Littig JPB, Moellmer R, Agrawal DK, Rai V. Future applications of exosomes delivering resolvins and cytokines in facilitating diabetic foot ulcer healing. World J Diabetes 2023; 14:35-47. [PMID: 36684384 PMCID: PMC9850797 DOI: 10.4239/wjd.v14.i1.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) increases the risk of many lethal and debilitating conditions. Among them, foot ulceration due to neuropathy, vascular disease, or trauma affects the quality of life of millions in the United States and around the world. Physiological wound healing is stalled in the inflammatory phase by the chronicity of inflammation without proceeding to the resolution phase. Despite advanced treatment, diabetic foot ulcers (DFUs) are associated with a risk of amputation. Thus, there is a need for novel therapies to address chronic inflammation, decreased angiogenesis, and impaired granulation tissue formation contributing to the non-healing of DFUs. Studies have shown promising results with resolvins (Rv) and anti-inflammatory therapies that resolve inflammation and enhance tissue healing. But many of these studies have encountered difficulty in the delivery of Rv in terms of efficiency, tissue targetability, and immunogenicity. This review summarized the perspective of optimizing the therapeutic application of Rv and cytokines by pairing them with exosomes as a novel strategy for targeted tissue delivery to treat non-healing chronic DFUs. The articles discussing the T2DM disease state, current research on Rv for treating inflammation, the role of Rv in enhancing wound healing, and exosomes as a delivery vehicle were critically reviewed to find support for the proposition of using Rv and exosomes in combination for DFUs therapy. The literature reviewed suggests the beneficial role of Rv and exosomes and exosomes loaded with anti-inflammatory agents as promising therapeutic agents in ulcer healing.
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Affiliation(s)
- Joshua P B Littig
- Translational Research, Western University of Health Sciences, Pomona, CA 91766, United States
| | - Rebecca Moellmer
- College of Podiatry, Western University of Health Sciences, Pomona, CA 91766, United States
| | - Devendra K Agrawal
- Translational Research, Western University of Health Sciences, Pomona, CA 91766, United States
| | - Vikrant Rai
- Translational Research, Western University of Health Sciences, Pomona, CA 91766, United States
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14
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Deng C, Meng Z, Chen H, Meng S. Tetramethylpyrazine ameliorates systemic streptozotocin-induced Alzheimer-like pathology. J Chem Neuroanat 2023; 127:102207. [PMID: 36470527 DOI: 10.1016/j.jchemneu.2022.102207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022]
Abstract
Diabetes mellitus (DM) and its complications are the main threats to the global disease burden. DM-related cognitive dysfunction is a progressive neurodegenerative disease, similar to Alzheimer's disease (AD). The underlying pathophysiology remains unclear, and an effective treatment is unavailable. Tetramethylpyrazine (TMP) is a bioactive ingredient extracted from the plant Ligusticum wallichii, which has anti-diabetic and neuroprotective properties. In this study, streptozotocin (STZ) injection was used to establish a mouse STZ-AD model, and TMP was administered through the lateral ventricle (ICV) to evaluate the effects of TMP on cognitive ability and neurochemical changes and to explore the underlying cellular and molecular mechanisms. Using MWM and Y-maze behavioral paradigms, we observed that TMP protected against STZ-induced learning and memory impairment. STZ promoted the deposition of amyloid plaques, activation of glial cells, loss of neurons and synapses, and reduction of synaptic plasticity. In contrast, TMP restored these aberrations and improved cognitive deficits in STZ-induced diabetic animals. Moreover, TMP attenuated hippocampal mitochondrial dysfunction and oxidative stress through modulation of the SIRT1/Nrf2/ HO-1 pathway. This evidence shows that TMP exerts its therapeutic effects through multiple pathways. Our study provides new insights into the neuroprotective effects of TMP for the treatment of diabetes-related cognitive failure.
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Affiliation(s)
- Chujun Deng
- Department of Traditional Chinese Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Zeyu Meng
- The Second Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Huize Chen
- Department of Traditional Chinese Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Shengxi Meng
- Department of Traditional Chinese Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China.
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Coman H, Stancu B, Gâvan NA, Bowling FL, Podariu L, Bondor CI, Radulian G. Diabetes-Related Lower Extremity Amputations in Romania: Patterns and Changes between 2015 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:557. [PMID: 36612876 PMCID: PMC9819762 DOI: 10.3390/ijerph20010557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Lower extremity amputations (LEAs) are a feared complication of diabetes mellitus (DM). Here we evaluated the recent trends in DM-related LEAs in Romania. We collected data from a national database regarding minor and major LEAs performed between 2015 and 2019 in patients with DM admitted to a public hospital. Absolute numbers of LEAs were presented by year, diabetes type, sex and age; incidence rates of LEAs in the general population were also calculated. Over the study period, 40,499 LEAs were recorded nationwide (83.16% in persons with type 2 DM [T2DM]); on average, the number of LEAs increased by 5.7%/year. This trend was driven by an increased number of LEAs in patients with T2DM; in patients with type 1 DM (T1DM), LEAs decreased over the study period. In patients with T2DM, the increase in minor LEAs was more pronounced than that in major LEAs. The overall number of LEAs showed an increasing trend with age (r = 0.72), which was most pronounced in patients aged ≥70 years. Men had a higher frequency of LEAs than women, regardless of DM type. These data support renewed efforts to prevent and decrease the burden of amputations among patients with DM.
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Affiliation(s)
- Horaţiu Coman
- Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania
| | - Bogdan Stancu
- Second Department of Surgery, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | | | - Frank L. Bowling
- Developmental Biomedicine Research Group, The University of Manchester, Manchester M13 9PL, UK
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Laura Podariu
- Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania
- “Nicolae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania
| | - Cosmina I. Bondor
- Department of Medical Informatics and Biostatistics, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Gabriela Radulian
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucureşti, Romania
- “Prof. Dr. Nicolae Paulescu” National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania
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Prognostic Value of Histological and Immunohistochemical Data in Diabetic Foot Ulcers. J Clin Med 2022; 11:jcm11237202. [PMID: 36498776 PMCID: PMC9737256 DOI: 10.3390/jcm11237202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetic foot ulcers are an extremely urgent medical and social problem throughout the world. The purpose of this study was to analyse the histological and immunohistochemical features of tissues and cells of different sections of wounds taken during the primary surgical treatment of chronic wounds in patients with diabetic foot syndrome with favourable and unfavourable outcomes. MATERIAL AND METHODS A clinical prospective observational study of the treatment outcomes of fifty-three patients with diabetic foot ulcers hospitalized twice in one specialized centre over the course of the year was conducted. The analysis of histological and immunohistochemical data of the tissues of the edges and the centre of the ulcer taken during the primary surgical treatment was performed. While performing histological analyses of wound tissues, special attention was given to the determination of cellular characteristics of leukocyte-necrotic masses, granulation tissue, and loose and dense connective tissue. Immunohistochemistry was performed using a set of monoclonal antibodies, allowing verification of neutrophilic leukocytes, fibroblasts, and endothelial cells. RESULTS Unfavourable outcomes (amputation, reamputation, death from cardiovascular diseases, nonhealing ulcer within a year) were registered in 52.8% of cases. Uniform distribution of neutrophils and endothelial cell fibroblasts in all parts of the wound was recorded in patients with a favourable outcome. An unfavourable outcome was predetermined by the uneven content of these cells with a significant increase in neutrophilic leukocytosis in the bottom of the wounds, as well as a significant decrease in the number of fibroblasts and endotheliocytes in the centre of the wounds. CONCLUSIONS The datasets obtained during primary surgical treatment are extremely informative to predict the outcome of the treatment of diabetic foot ulcers and indicate more active surgical strategies with the potential to reduce the treatment time, increase its effectiveness, and eventually make the treatment cost-effective.
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Influence of Health Education on Podiatric Knowledge, Self-care, and Conditions in Adults With Diabetes Mellitus: A Systematic Review. Adv Skin Wound Care 2022; 35:675-679. [PMID: 36179316 DOI: 10.1097/01.asw.0000884328.49506.7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine if health education has an influence on podiatric knowledge, self-care, and conditions in adults with diabetes mellitus. DATA SOURCES The authors conducted a literature search for Spanish-, English-, and Portuguese-language publications using PubMed, Scopus, Dialnet, and CUIDEN. STUDY SELECTION Selected keywords related to diabetes, health education, (diabetic) foot, and self-care were searched, and the titles, abstracts, and relevant full-text articles were screened. Thirteen studies were selected with a total of 1,296 participants. Four were randomized controlled trials, and nine were quasi-experimental studies. DATA EXTRACTION Data pertaining to preventive intervention and study outcomes were extracted. DATA SYNTHESIS The preventive interventions used varied from traditional educational workshops and one-on-one patient education to new technological strategies. Three different outcomes were evaluated in each study: podiatric knowledge (n = 4), foot self-care (n = 13), and foot problems (n = 2). CONCLUSIONS Health education interventions increase podiatric self-care in adults with diabetes mellitus. These interventions appear to contribute positively to foot health and podiatric knowledge.
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Novel Biomarkers Predictive of Diabetic Charcot Foot-An Overview of the Literature. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111944. [PMID: 36431079 PMCID: PMC9698200 DOI: 10.3390/life12111944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
Background: Although Charcot diabetic foot (CDF) is a frequent complication of diabetic neuropathy, less is known about the possibility of its early prevention. Methods: A review of the original articles published in English, using the "biomarkers AND Charcot's foot" criterion, resulted in 33 articles from the PubMed database and seven articles from the Web of Science database. The five duplicates were eliminated, and two independent reviewers selected the most relevant articles, leaving a total of 21 articles. Results: The biomarkers identified are exhaustively described, related to the system of advanced glycation end products (AGEs) and their soluble receptors (sRAGE), inflammatory cascade, osteoclastogenesis, and, respectively, osteoblastic activity. Conclusions: This article highlights the importance of potential early identifiable biomarkers that can lead to microstructural changes in the affected bones.
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Uribe-Querol E, Rosales C. Neutrophils Actively Contribute to Obesity-Associated Inflammation and Pathological Complications. Cells 2022; 11:1883. [PMID: 35741012 PMCID: PMC9221045 DOI: 10.3390/cells11121883] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity is characterized by an increase in body weight associated with an exaggerated enlargement of the adipose tissue. Obesity has serious negative effects because it is associated with multiple pathological complications such as type 2 diabetes mellitus, cardiovascular diseases, cancer, and COVID-19. Nowadays, 39% of the world population is obese or overweight, making obesity the 21st century epidemic. Obesity is also characterized by a mild, chronic, systemic inflammation. Accumulation of fat in adipose tissue causes stress and malfunction of adipocytes, which then initiate inflammation. Next, adipose tissue is infiltrated by cells of the innate immune system. Recently, it has become evident that neutrophils, the most abundant leukocytes in blood, are the first immune cells infiltrating the adipose tissue. Neutrophils then get activated and release inflammatory factors that recruit macrophages and other immune cells. These immune cells, in turn, perpetuate the inflammation state by producing cytokines and chemokines that can reach other parts of the body, creating a systemic inflammatory condition. In this review, we described the recent findings on the role of neutrophils during obesity and the initiation of inflammation. In addition, we discuss the involvement of neutrophils in the generation of obesity-related complications using diabetes as a prime example.
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Affiliation(s)
- Eileen Uribe-Querol
- Laboratorio de Biología del Desarrollo, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Carlos Rosales
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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Huang ZX, Zhang HH, Huang Y, Ye SL, Ma YN, Xin YH, Chen XQ, Zhao S. Association of time in range with postoperative wound healing in patients with diabetic foot ulcers. Int Wound J 2021; 19:1309-1318. [PMID: 34931460 PMCID: PMC9493226 DOI: 10.1111/iwj.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/22/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022] Open
Abstract
Time in range (TIR) is a novel indicator of glycaemic control that has been reported to have an association with diabetic complications. The objective of the study was to explore the association of TIR with postoperative wound healing in patients with diabetic foot ulcers (DFUs). We retrospectively analysed the data of DFU patients who had undergone surgical treatment from 2015 to 2019. A 1:1 ratio in propensity score matching (PSM) was adopted to compare patients with TIR ≥50% with those <50%. Data were summarised using chi-squared, Fisher's exact, and Mann-Whitney U tests. Patients with TIR <50% underwent a higher rate of secondary surgery within a month (P = .032) and had a longer hospital stay (P = .045) with greater hospital charges (P < .001) than the TIR ≥50% group. Multivariate analysis revealed that TIR (P = .034), Wagner score (P = .009), diabetes treatment (P = .006), and type of surgery (P = .013) were independent risk factors for secondary surgery. Additionally, patient subgroups with TIR <50% and baseline HbA1c < 7.5% (P = .025), albumin level ≥ 30 g/L (P = .039), HDL < 1.16 (P = .021), or Wagner score ≥ 3 (P = .048) also experienced a higher incidence of secondary surgery. TIR was correlated with postoperative wound healing in patients with DFUs. Strict glycaemic targets should be established for surgical patients.
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Affiliation(s)
- Ze-Xin Huang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui-Hui Zhang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Huang
- Department of Burns Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Infection, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng-Lie Ye
- Department of Burns Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu-Ning Ma
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying-Huan Xin
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Qian Chen
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng Zhao
- Department of Burns Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Kozińska B, Szlenk-Czyczerska E. Assessment of nursing and midwifery students’ knowledge
of treatment of diabetic foot syndrome using Lucilia servicata larvae. MEDICAL SCIENCE PULSE 2021. [DOI: 10.5604/01.3001.0015.6233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. Diabetes mellitus is one of the most common chronic diseases, and
in recent years its prevalence has been systematically increasing. Untreated or ineffectively treated diabetes leads to the development of many complications. Among these that can significantly affect the quality of life is diabetic foot syndrome (DFS). Larvotherapy is a therapeutic method of treating wounds arising during the course of DFS.
Aim of the study. The main objective of this study was to assess the level of knowledge
of nursing and midwifery students on the treatment of DFS using Lucilia sericata larvae.
Material and Methods. This study is a cross-sectional, observational study in which 202 nursing and midwifery students of Opole University were surveyed. The study was conducted online between June and November 2020, using a questionnaire developed by the authors.
Results. The analysis showed considerable variation in the level of students' knowledge of treatment techniques for DFS. Those with the highest level of knowledge represented 39.15% (n=79), the average level of knowledge was represented by 28.2% (n=57), and the lowest level of knowledge was represented by 32.7% (n=66) of students. Regarding biosurgery in general, the highest level of knowledge about biosurgery was represented by 48.0% (n=97) of students. Nursing students had a higher level of knowledge than midwifery students regarding DFS treatment methods (p=0.001). There was no difference in the level of knowledge about biosurgery between nursing and midwifery students (p=0.503).
Conclusions. The research presented in this study indicates that nursing and midwifery students have insufficient knowledge of DFS treatment methods and biosurgery. Nursing students are more likely than midwifery students to derive knowledge of DFS treatment methods from their studies and the literature. Education on treatment methods and techniques for DFS should be increased among students. Students' knowledge can be increased by classes in the course of their education and meetings with professionals.
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22
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Analysis of the association of polymorphisms of genes markers functions of endothelium and vascular-plate hemostasis with development of diabetic foot syndrome. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim. To study the prevalence of various combinations of polymorphic variants of genes markers of endothelial function and vascular-platelet hemostasis in the development of diabetic foot syndrome.Materials and methods. In 198 patients with uncomplicated diabetes mellitus and 199 patients with diabetic foot syndrome, the frequency of polymorphic variants of the NOS 786C>T, END1 Lys198Asn, ITGB3 1565T>C (Leu33Pro), F5 1691G>A, F2 20210G>A, MMP9 8202A>G, MTHFR 1298A>C, VEGFA-634C>G genes was studied. Using binary logistic regression analysis, the relationship of various combinations of polymorphisms of the studied genes with the development of diabetic foot was assessed.Results. In diabetic foot syndrome, the most significant contribution is made by the combination of polymorphic variants of the ITGB3 1565T>C (Leu33Pro) and MTHFR 1298A>C genes. With the development of this complication of diabetes mellitus, a combination of the 1565 TC polymorphism of gene ITGB3 and the 1298AA polymorphism of gene MTHFR is 2.1 times more common. The association of the 1565TT polymorphism of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is 2 times more common in diabetes mellitus without complications.Conclusion. The combination of the 1565TС polymorphism of gene ITGB3 and the 1298АА polymorphism of gene MTHFR is associated with the risk of developing a diabetic foot and increases the risk of developing this complication by 2.4 times. The presence of a combination of the 1565TT polymorphisms of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is more common in uncomplicated diabetes mellitus, which suggests its protective effect against the development of diabetic foot syndrome.
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Kupczyk D, Bilski R, Przewięźlikowski A, Studziñska R, Woźniak A. Concentration of proinflammatory cytokines in patients with ulcers as a complication of type 2 diabetes mellitus. Postepy Dermatol Alergol 2021; 38:767-772. [PMID: 34849122 PMCID: PMC8610058 DOI: 10.5114/ada.2020.96702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Difficult healing of chronic wounds is a serious problem for modern medicine. It leads to ulceration, especially in conditions such as diabetic foot syndrome or chronic venous insufficiency. This may be a result of chemical, physical, thermal or biological factors, among others. Analysis of mediators and molecular factors released by the abovementioned structure helps to better understand the mechanism of healing of chronic wounds and the formation of ulcers. AIM To assess excretion of selected cytokines in patients with ulcerations as a complication of diabetes mellitus type 2. MATERIAL AND METHODS Seventeen patients aged 68-87 took part in the assessment of wound healing in patients with ulceration in the course of diabetes mellitus type 2. The control group consisted of 21 healthy patients aged 32-62. In the blood serum bFGF, TNF-α, IL-4, TGF-β1, TGF-β2 and TGF-β3 were determined. RESULTS A significant difference was found in bFGF, IL-4, TGF-β1, TGF-β2, and TGF-β3 levels. Concentration of bFGF was 12% lower in patients with ulcers than in the non-ulcerated control group (p = 0.013). IL-4 concentration was 46% lower in patients with ulcers than in the non-ulcerated control group (p = 0.002). TGF-β1, TGF-β2 and TGF-β3 concentrations were also lower in the group of patients with ulcers compared to those in the non-ulcerated control group. CONCLUSIONS Reduced concentrations of selected cytokines and growth factors may indicate abnormal activity of the cells that secrete them and affect the healing process of chronic wounds, hindering and delaying the healing process.
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Affiliation(s)
- Daria Kupczyk
- Department of Medical Biology and Biochemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Rafał Bilski
- Department of Medical Biology and Biochemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | | | - Renata Studziñska
- Department of Organic Chemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Peng B, Min R, Liao Y, Yu A. Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer. J Diabetes Res 2021; 2021:6621035. [PMID: 33511218 PMCID: PMC7822701 DOI: 10.1155/2021/6621035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). METHODS AND MATERIALS In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. RESULTS 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. CONCLUSION Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.
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Affiliation(s)
- Bocheng Peng
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Rui Min
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yiqin Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, China
| | - Aixi Yu
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Seghieri G, De Bellis A, Seghieri M, Gualdani E, Policardo L, Franconi F, Francesconi P. Gender Difference in the Risk of Adverse Outcomes After Diabetic Foot Disease: A Mini-Review. Curr Diabetes Rev 2021; 17:207-213. [PMID: 32674734 DOI: 10.2174/1573399816666200716195600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/22/2022]
Abstract
Diabetic foot disease (DFD) is a complication of diabetes mellitus, characterized by multiple pathogenetic factors, bearing a very high burden of disability as well as of direct and indirect costs for individuals or healthcare systems. A further characteristic of DFD is that it is associated with a marked risk of subsequent hospitalizations for incident cardiovascular events, chronic renal failure or of allcause mortality. Additionally, DFD is strongly linked to the male sex, being much more prevalent among men. However, even if DFD mainly affects males, several past reports suggest that females are disadvantaged as regards the risk of subsequent adverse outcomes. This review aims to clarify this point, attempting to provide an explanation for this apparent oddity: being DFD a typically male complication of diabetes but, seemingly, with a greater load of subsequent consequences for females.
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Affiliation(s)
| | - Alessandra De Bellis
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Marta Seghieri
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio" Hospital, Florence, Italy
| | | | | | - Flavia Franconi
- National Laboratory of Gender Medicine and Gender Pharmacology of National Institute of Biostructures and Biosystems, University of Sassari, Italy
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Zhang Y, Lazzarini PA, McPhail SM, van Netten JJ, Armstrong DG, Pacella RE. Global Disability Burdens of Diabetes-Related Lower-Extremity Complications in 1990 and 2016. Diabetes Care 2020; 43:964-974. [PMID: 32139380 DOI: 10.2337/dc19-1614] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/28/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE No study has reported global disability burden estimates for individual diabetes-related lower-extremity complications (DRLECs). The Global Burden of Disease (GBD) study presents a robust opportunity to address this gap. RESEARCH DESIGN AND METHODS GBD 2016 data, including prevalence and years lived with disability (YLDs), for the DRLECs of diabetic neuropathy, foot ulcer, and amputation with and without prosthesis were used. The GBD estimated prevalence using data from systematic reviews and DisMod-MR 2.1, a Bayesian meta-regression tool. YLDs were estimated as the product of prevalence estimates and disability weights for each DRLEC. We reported global and sex-, age-, region-, and country-specific estimates for each DRLEC for 1990 and 2016. RESULTS In 2016, an estimated 131 million people (1.8% of the global population) had DRLECs. An estimated 16.8 million YLDs (2.1% global YLDs) were caused by DRLECs, including 12.9 million (95% uncertainty interval 8.30-18.8) from neuropathy only, 2.5 million (1.7-3.6) from foot ulcers, 1.1 million (0.7-1.4) from amputation without prosthesis, and 0.4 million (0.3-0.5) from amputation with prosthesis. Age-standardized YLD rates of all DRLECs increased by between 14.6% and 31.0% from 1990 estimates. Male-to-female YLD ratios ranged from 0.96 for neuropathy only to 1.93 for foot ulcers. The 50- to 69-year-old age-group accounted for 47.8% of all YLDs from DRLECs. CONCLUSIONS These first-ever global estimates suggest that DRLECs are a large and growing contributor to the disability burden worldwide and disproportionately affect males and middle- to older-aged populations. These findings should facilitate policy makers worldwide to target strategies at populations disproportionately affected by DRLECs.
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Affiliation(s)
- Yuqi Zhang
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia .,Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Steven M McPhail
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Jaap J van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Rosana E Pacella
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute for Lifecourse Development, University of Greenwich, London, U.K
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